93RD GENERAL ASSEMBLY
State of Illinois
2003 and 2004
HB7033


 
Introduced 02/09/04, by Kenneth Dunkin
 
SYNOPSIS AS INTRODUCED:
 		












215 ILCS 5/368f new











    Amends the Illinois Insurance Code.  Provides that accident and health insurers and health care professionals and health care providers shall have the ability to accept and submit claims electronically in accordance with federal standards.  Provides for the Department of Insurance to establish a timetable for compliance.  Establishes an exemption for long term care facilities and community-integrated living arrangements.  Effective immediately.
















LRB093 15407 SAS 41010 b

















FISCAL NOTE ACT MAY APPLY
















 


 


A BILL FOR









 











HB7033

LRB093 15407 SAS 41010 b






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    AN ACT concerning provider billing.

 
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    Be it enacted by the People of the State of Illinois,
 
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represented in the General Assembly:


 
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    Section 5. The Illinois Insurance Code is amended  by adding 
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Section 368f as follows:
 
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    (215 ILCS 5/368f new)

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    Sec. 368f. Requirement to enable electronic exchange of 
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information.
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    (a) An accident and health insurer licensed in Illinois 
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shall have the
ability to accept health claims
or equivalent 
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encounter information, referral certification, authorization, 
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and
eligibility transactions
electronically and shall utilize 
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the federal standards for these electronic
transactions 
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established by
the Department of Health and Human Services 
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pursuant to Section 262 of
Pub.L. 104-191 (42
U.S.C. 1320d et 
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seq.) and Part 162 of Title 45, Code of Federal Regulations.
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    A health care professional or health care facility that is

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licensed to provide health care
services in Illinois and that 
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accepts patients who are enrolled in an
individual
health plan 
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or a group
health plan, including a health insurance issuer 
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offering coverage through the
group health plan,
Medicaid, or 
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the State employee health plan shall submit health claims or

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equivalent encounter
information, referral certification, 
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authorization, and eligibility
transactions
electronically and 
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shall
utilize the federal standards for these electronic 
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transactions established by
the Department of
Health and Human 
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Services pursuant to Section 262 of Pub.L. 104-191 (42
U.S.C. 
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1320d et seq.)
and Part 162 of Title 45, Code of Federal 
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Regulations.
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    (b) The Department shall establish a
timetable
for 
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implementation of the electronic transmission of health care 
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transactions.
The timetable shall
not require implementation 
 


 






HB7033
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prior to the compliance date set forth by the U.S.
Department 
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of Health
and Human Services for federal standards for 
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electronic health care
transactions pursuant to Section
262 of 
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Pub.L. 104-191 (42 U.S.C. 1320d et seq.) and Part 162 of Title 
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45, Code
of Federal
Regulations or any extension granted by the 
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Secretary of Health and Human
Services to comply with
the 
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federal standards.
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    (c) The Director may temporarily waive the application of 
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this Section in
cases in which:

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        (1) there is no method available for the submission of 
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    claims in an
electronic
form; or

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        (2) the entity submitting the claim is a small health 
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    care professional or
health care facility
with fewer than 
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    10 full-time equivalent employees that has demonstrated 
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    that
compliance with
this Act will result in an undue 
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    hardship or other special circumstance on the
health care 
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    professional
or health care facility.

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    (d) The Department
shall establish an application and 
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review process for health care
professionals and health
care 
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facilities with identified special circumstances no later than 
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6 months
prior to the effective date
of implementation as 
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determined under subsection (b).

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    (e) The Department
shall
report to the Governor and the 
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General Assembly within one year after
establishing the

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timetable pursuant to
this Section, and at least annually 
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thereafter, on the number of extensions
or temporary waivers of

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the implementation requirement that it has granted pursuant to

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subsection (c), the
reasons therefor, and recommendations to 
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overcome obstacles to full compliance
by affected health
care 
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professionals and health care facilities.

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    (f) Beginning
January 1, 2005, an individual health plan or 
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a group health plan,
including a health insurance
issuer 
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offering coverage through the group health plan, or a state 
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agency
administering a
government health plan, may not deduct 
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more than a $2 per claim service fee
for adjudication of
any 
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paper health claims.
 


 






HB7033
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    (g) This Section does not apply to long-term care 
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facilities licensed under the Nursing Home Care Act or to 
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community-integrated living arrangements operated under the 
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Community-Integrated Living Arrangements Licensure and 
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Certification Act.


 

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    Section 99. Effective date. This Act takes effect upon 
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becoming law.